{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Michael M Ham","gend":0,"currentgend":"","add":"96 WOOD SCHOOL HOUSE RD","city":"Bowdoin","state":"ME","zip":"04287","dob":"1956-07-04","age":"","mstatus":"","insh":"10000090606","cliId":"","pno":2074411623,"cno":"","email":"mckenna564@yahoo.com","ename":"","eno":"","pphy":"GREENLEAF, REBECCA","ppno":2077952800,"pcpadd":"76 HIGH ST FL 1,","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407649","pcpcounty":"","pcpid":"","pcpname":"TOPSHAM FAMILY MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"96 WOOD SCHOOL HOUSE RD","madd2":"","madd3":"","mcity":"Bowdoin","mstate":"ME","mzip":"04287","pcpfaxno":2077952808,"pcpnpi":1164782819,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"6AM8R19FN67","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z0000","R21","I10","C099","G4733","E041","J329","Z0100","H35363","H52221","Z48810","M25511","C109","G4730","M1990","M19011","B079","M2550","K1379","Z85818","Z87891","Z8589","M4722","Z8781","M4696","H1033","H6693","E7800","Z125","R09A2","Z049","E042","L0231","R0981","I8390","J342","E785","R4182","J343","L989","M7712","E663","L258","R6889","R935","I2510","I517","M25579","R0683","Z1211","K5730","K640","G5602","G5603","M5412"],"date":["2025-07-16","2024-04-01","2025-07-21","2025-06-30","2024-04-09","2025-08-07","2024-10-29","2025-06-17","2025-06-17","2023-05-02","2024-02-12","2025-02-05","2024-04-09","2024-04-09","2024-04-09","2023-03-22","2025-01-06","2023-03-23","2025-02-10","2025-07-30","2025-07-30","2025-06-30","2023-10-05","2023-10-05","2023-10-05","2025-03-06","2025-03-06","2023-10-05","2023-10-05","2025-07-30","2024-02-12","2024-02-21","2024-03-06","2022-12-21","2023-10-24","2023-06-14","2024-01-03","2024-01-03","2023-06-14","2024-12-03","2023-06-21","2023-01-05","2025-07-01","2023-03-12","2024-10-29","2024-10-29","2024-10-29","2022-11-22","2022-10-25","2022-09-27","2022-09-27","2022-09-27","2022-08-12","2022-08-16","2022-08-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","DICLOFENAC SODIUM","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","METHYLPREDNISOLONE","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","HYDROCODONE-ACETAMINOPHEN","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CLOTRIMAZOLE-BETAMETHASONE","","","Select","Select",""],["","","IMIQUIMOD","","","Select","Select",""],["","","FLUZONE HIGH-DOSE TRIV 2024-25","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","CHLORHEXIDINE GLUCONATE","","","Select","Select",""],["","","DOXYCYCLINE MONOHYDRATE","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","AMOXICILLIN","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","PREVNAR 13","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}